June 2018
Billing chart: Blues highlight medical, benefit policy changes
You’ll find the latest information about procedure codes and Blue Cross Blue Shield of Michigan billing guidelines in the following chart.
This billing chart is organized numerically by procedure code. Newly approved procedures will appear under the New Payable Procedures heading. Procedures for which we have changed a billing guideline or added a new payable group will appear under Updates to Payable Procedures. Procedures for which we are clarifying our guidelines will appear under Policy Clarifications. New procedures that are not covered will appear under Experimental Procedures.
You will also see that descriptions for the codes are no longer included. This is a result of recent negotiations with the AMA on use of the codes.
We will publish information about new BCBS groups or changes to group benefits under the Group Benefit Changes heading.
For more detailed descriptions of the BCBSM policies for these procedures, please check under the Medical/Payment Policy tab in Explainer on web-DENIS. To access this online information:
- Log in to web-DENIS.
- Click on BCBSM Provider Publications & Resources.
- Click on Benefit Policy for a Code.
- Click on Topic.
- Under Topic Criteria, click on the drop-down arrow next to Choose Identifier Type and then click on HCPCS Code.
- Enter the procedure code.
- Click on Finish.
- Click on Search.
Code* |
BCBSM changes to:
Basic Benefit and Medical Policy, Group
Variations Payment Policy, Guidelines
|
NEW PAYABLE PROCEDURES |
J9999 |
Basic benefit and medical policy
FDA approves Ogivri (trastuzumab-dkst)
Ogivri (trastuzumab-dkst) was approved by the U.S. Food and Drug Administration as a biosimilar to Herceptin® (trastuzumab) for the treatment of patients with breast or metastatic stomach cancer (gastric or gastroesophageal junction adenocarcinoma) whose tumors overexpress the HER2 gene (HER2+), effective Dec. 1, 2017.
Ogivri (trastuzumab-dkst) isn’t covered by URMBT groups. |
UPDATES TO PAYABLE PROCEDURES |
J0588 |
Basic benefit and medical policy
Additional codes
J0588 is now payable for the following additional diagnosis of:
- G8110
- G8111
- G8112
- G8113
- G8114
|
GROUP BENEFIT CHANGES |
SpartanNash |
SpartanNash is now offering the Your Dedicated Nurse program through Blue Cross, effective April 1, 2018. This is a tailored care management program that coordinates member care and manages health care cost through personalized member interventions. Learn more in an article in this issue.
Group number: 71575
Alpha prefix: PPO (NSS)
Platform: NASCO
Plans offered:
PPO
High-deductible health plan Plus
High-deductible health plan Basic |
|